For many people, a picture is much more instructive and memorable than text. The second edition of the Atlas of Breast Cancer is designed for such people. With 154 pages and 213 figures, it is a graphic overview of the pathophysiology, diagnosis, and treatment of breast cancer.
The atlas is divided into 13 chapters, focusing on the major areas of breast cancer care, including anatomy, prevention, diagnosis, and treatment. Consistent with the philosophy of an atlas, it is light on text and heavy on graphics. The pages are filled with tables, graphs, and photographs. Chapters 1 through 4 serve as an introduction to the topic, covering epidemiology, normal anatomy, breast cancer development, and prevention. Chapters 5 through 9 focus on the diagnosis of breast cancer, covering breast imaging, biopsy techniques, and pathology. In the imaging chapter, screening recommendations and the mammographic features of breast cancer are discussed. The pathology chapters cover the processing of breast biopsies as well as breast cancer pathology. Benign breast disorders are discussed in a separate chapter.
Chapters 10 through 13 cover the local and systemic aspects of breast cancer therapy including surgical treatment of early breast cancer, radiation concepts, and systemic treatment of both early-stage and advanced disease. In general, the individual chapters are well written and provide a good overview of their subjects. The graphics enhance the text and include detailed captions. The mammographic and pathologic images are well chosen and clear.
The strengths of the book are its accessibility to the nonexpert as well as its comprehensive scope. In the preface, Dr. Hayes states that his primary goal was to create a single source of information that could serve as a rapid update on breast cancer for the nonexpert. I believe that he has achieved his goal. The book provides a relatively quick overview of the important areas of breast cancer care.
One shortcoming, however, lies in the breast conservation sections of the surgical and radiation chapters. I found the discussion of the management of invasive tumors without an extensive in situ component to be somewhat confusing and, in some places, contradictory. Also, in the section on biopsies, the authors state that radiation therapy is the recommended primary treatment even when infiltrating tumor is present at the margin. Although the definition of what constitutes a "clean" margin is somewhat controversial, most physicians would agree that the optimal situation is to not have tumor present at the inked margin, even if this requires re-excision. In fact, the breast cancer guidelines of the National Comprehensive Cancer Network consider involved-margin status after re-excision to be a relative contraindication to breast-conservation therapy. I am concerned that these points will not be clear to the nonexpert for whom this book is designed.
In conclusion, this atlas will be most valuable to physicians in training as well as general physicians and nononcology specialists, especially those with an interest in women’s health care. For these groups, it offers a concise update on breast cancer care in an appealing format.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
